|ICSI||Elective single embryo transfer (eSET)|
|Surgical sperm recovery||Vitrification|
|Blastocyst culture||Sperm freezing|
|Genetic testing of embryos (PGD/PGS)||Egg freezing|
Intracytoplasmic Sperm Injection (ICSI)
ICSI is a lab technique whereby a single sperm is selected for injection into each egg in order to increase the rate of fertilisation for couples with poor sperm quality.
Who is it for?
ICSI is a variant of IVF carried out when semen quality appears very poor
- Very low sperm count (oligozoospermia)
- Very poor sperm motility (asthenozoospermia)
- Very low numbers of normal sperm (teratozoospermia)
These problems can occur in isolation or frequently in combination with each other. They are identified at initial semen analysis and confirmed following a repeat semen analysis with specialised sperm preparation.
What does it involve?
The female undergoes an IVF treatment cycle (see IVF). Following egg collection, instead of mixing the sperm and eggs in a petri dish and allowing fertilisation to occur a specialised laboratory procedure is used to help the sperms fertilise the egg.
This involves directly injecting a single moving sperm into each of the collected eggs. Once the procedure is complete, the eggs injected with sperm are monitored over a 24 hour period to check if fertilisation has occurred. Click here for video clip.
After fertilisation has been achieved, the embryos are incubated in a high quality culture medium for three to five days from egg collection. The best embryo(s) are then selected for transfer into the womb.
Surgical Sperm Recovery
Who is it for?
For men with no sperm in the ejaculate (azoospermia). There are two types of azoospermia:
Most frequently due to an absent or blocked vas deferens (the tube connecting the testicle to the penis) resulting in the sperm not reaching the ejaculate. This may occur following vasectomy or in carriers of the cystic fibrosis gene. These patients have a high chance of finding sperm at the time of surgery.
This is due to abnormal sperm production and may occur for a variety of reasons- genetic, testicular failure due to undescended testes, varicocoele. The chance of finding sperm at the time of surgery is very much dependent on the underlying cause.
What does it involve?
There are several methods of surgical sperm retrieval. They are used in conjunction with ICSI treatment.
Percutaneous Epididymal Sperm Aspiration (PESA)
Testicular Sperm Extraction (TESE)
TESE is generally performed when PESA is unsuccessful. In this procedure, a small incision is made in the scrotum and testis and a biopsy of testicular tissue is taken. This tissue is examined carefully under the microscope for motile sperm, which are then extracted for use in an ICSI cycle. The procedure is performed in the clinic under sedation and local anaesthesia.
Microsurgical Testicular Sperm Extraction (Micro-TESE)
Micro-TESE is a more advanced procedure for men whose basic problem is failure to produce sperm cells. The procedure involves carrying out targeted dissection of tiny tubes within the testicle, which are more likely to contain sperm. A high powered microscope is used during the procedure to distinguish between healthy and unhealthy tissue. The healthy tissue samples are then examined in the laboratory. If viable sperm is found, it is prepared and frozen for use in a subsequent ICSI cycle. Waterstone clinic, together with Dr Ivor Cullen, Consultant Urologist and Andrologist, is proud to have established the first microTESE service in Ireland.
Genetic testing of embryos
At Waterstone Clinic we are proud to offer the first successful pre-implantation genetic testing service. Pre-implantation genetic diagnosis (PGD) was first introduced at Waterstone Clinic in 2012 resulting in the first baby born from PGD in Ireland. Subsequently pre-implantation genetic screening was introduced in 2014 as a treatment option.
Pre-implantation Genetic Diagnosis (PGD)
Pre-implantation genetic diagnosis (PGD) is a laboratory technique following IVF/ICSI treatment that enables couples, known to be at risk of or have a specific inherited condition, to reduce the risk of passing it on to their children.
Who is it for?
Genetic testing of embryos may be recommended where:
- Couples already have a child with a serious genetic condition
- Couples have a family history of a serious genetic condition or have the condition themselves
- Couples have found out that they are both carriers for the condition
We carry out PGD for single gene disorders including:
- Cystic Fibrosis
- Fragile X syndrome
- Duchenne Muscular Dystrophy
- Myotonic dystrophy
- Tay- Sachs disease
- Haemophilia A
- Sickle cell disease
What does it involve?
The PGD process involves generating a number of pre-implantation embryos through IVF treatment and checking the genes of those embryos for the condition involved. PGD involves one extra step within an IVF cycle.
- Following egg collection, the eggs are fertilized with prepared sperm to create embryos.
- These embryos are cultured and monitored for progression
- After either three or five days, embryos which appear to be developing normally are suitable for PGD embryo biopsy and genetic analysis. (see information leaflet here for more detailed description of the biopsy process)
- The genetic analysis of each removed cell takes place at a specialist genetic centre in the UK
- The embryo(s) that are diagnosed as not affected with the specific condition are then selected for transfer into the womb or cryopreservation for use in a future frozen embryo transfer cycle
Important limitations of PGD
Couples are advised that pre-implantation analysis is not yet considered to be a standard technique and consequently we highly recommend that patients who become pregnant from PGD have prenatal testing using CVS or amniocentesis. Prenatal testing will reveal whether or not the PGD testing analysis was correct and confirm whether or not the foetus has been affected by the specific genetic disease. Of those embryos diagnosed, PGD for a single gene disorder detects about 95% of affected embryos. This means that misdiagnoses can occur. PGD is not a substitute for prenatal testing.
PGD is aimed at reducing your chances of having a child with a specific genetic disease, however it does not test for all birth defects.
It is not possible to obtain a diagnostic result from every cell tested. Approximately 10% will be undiagnosed after PGD.
For further information about the PGD programme please contact us.
Pre-implantation Genetic Screening (PGS)
PGS involves generating a number of embryos through IVF treatment and checking that those embryos have the correct number of chromosomes. PGS involves one extra step within an IVF cycle.
Who is it for?
- Couples who have experienced recurrent and unexplained miscarriage
- Couples who have had repeated unsuccessful IVF cycles- where good quality embryos have been transferred into the womb yet pregnancy has not resulted.
- Advanced female age (it is well-recognised that the risk of aneuploidy increases with increasing maternal age)
What does it involve?
With PGS, embryos are generated using a form of IVF treatment known as intracytoplasmic sperm injection (ICSI). They are then screened to find out if they have the correct number of chromosomes. Embryos with a normal number of chromosomes are then transferred into the woman’s uterus.
Limitations of PGS
Theoretically, the transfer of a genetically normal embryo should increase the chance of a successful pregnancy and decrease the chance of miscarriage. However, PGS is not recommended for every couple doing IVF treatment as the addition of PGS has not been shown to improve overall livebirth rates in the general IVF population.
Conventional IVF involves culturing embryos for 3 days after egg collection, with embryo transfer on day three. Blastocyst culture involves growing embryos in media for a further two to three days to allow their cells to divide many more times and develop in a blastocyst.
This extended culture allows the trained eye of the embryologist to choose the very best embryo in order to maximise the chance of pregnancy.
At Waterstone clinic we have invested in the most advanced time-lapse technology – the Embryoscope plus. Unlike most other fertility clinics we do not charge our patients for embryo incubation in the Embryoscope.
Embryoscope+ is the most advanced Embryoscope on the market allowing for greater embryo capacity. It is a very reliable incubator offering stable temperature and gas conditions that incorporates a camera that regularly captures cell division as the embryo develops. These images can be reviewed at any time by our team of highly trained embryologists without removing the embryos from the incubator. The use of this technology can aid in the selection of the best quality embryo for transfer in situations where embryo selection is proving difficult.
Many clinics claim that the use of time-lapse incubation itself improves livebirth rates from IVF/ICSI treatment. We strongly believe in the skill of our highly trained embryologists, who have consistently delivered superior success rates at our clinic, and view Embryoscope as an aid to their expertise.
Elective Single Embryo Transfer Programme (e-SET)
Waterstone Clinic was the first clinic to introduce a successful blastocyst programme to Ireland where embryos are cultured for 5-6 days in the laboratory before transfer. This lead to actively promoting blastocyst culture with elective Single Embryo Transfer (e-SET).
Elective single embryo transfer is promoted as gold standard practice by international regulatory bodies. The aim is to reduce the incidence of twin pregnancies which are inherently more complicated than pregnancies with one baby.
The e-SET programme at Waterstone Clinic is highly successful. Currently the live birth rate for first-time IVF/ICSI treatment is 62% for women aged 40 and under.
Extended culture allows the scientist to choose the embryo with the best potential to achieve a pregnancy for transfer. Additional good quality embryos that are not transferred in a fresh cycle will be vitrified (frozen) and stored for future use giving the couple a very high chance of a second baby.
These advances have made it possible to reduce the incidence of IVF twin pregnancies for couples without reducing their chance of success. Thus, e-SET is an effective and safe way to build families, one healthy baby at a time minimising risks of pregnancy while maintaining high pregnancy rates.
At Waterstone Clinic, we use a technique known as vitrification to freeze embryos. This involves freezing the embryo about 600 times faster than in conventional slow rate freezing. This ultra-rapid process is so fast that it allows no time for ice crystals to form in the embryo. As a result, vitrification avoids trauma to the embryo.
Slow-rate (conventional) freezing methods had significantly poorer success rates. This was due to 20-30% of embryos not surviving the freeze-thaw process, and those that did survive had less than 50% chance of resulting in a pregnancy than freshly transferred embryos. In contrast, vitrified embryos have a greater than 80% freeze-thaw survival rate, and a pregnancy generating potential that is comparable to fresh embryos.
Cryopreservation (of Sperm and Embryos)
Cryopreservation is a term used to indicate the freezing of embryos, using vitrification, in order to preserve them for future use. Our cryopreservation programme allows us to preserve additional embryos or sperm that have not been required in a fresh cycle. For patients, this means an extra opportunity to return for treatment without having to undergo ovarian stimulation.